Normal Hair Growth Cycles
Undisturbed, each terminal scalp hair usually grows constantly for about approximately three to five years. Then, the locks transitions into a resting state where the visible portion above the skin is drop. No locks grows from the follicle for 90 days. Once this time around has passed, a new locks begins growing through the skin and continues for another three to five years at a rate of approximately 1/2 inch per month.
It is thought that as many as 100 genes are involved in regulating the creation, structure and cycling of scalp locks. To date, very few of these genes have been identified.
Common Pattern Hair Loss
Hamilton-Norwood Hair Loss Scale
For those concerned about hair loss, many myths and half-truths abound, but useful information can be difficult to obtain. Therefore, an objective overview of pattern hair loss is presented herein.
In healthy well-nourished individuals of both genders, the most common form of hair loss is androgenetic alopecia (AGA), known as pattern hair loss also. The disorder affects around 40 million American males. Perhaps surprisingly, the same condition affects about 20 million American women. The difference between men and women is that a woman suffering hair loss usually retains her feminine hairline and experiences thinning behind this leading edge. In men, a distinct “pattern” of loss manifests where the frontal edge recedes at the same time that a thinning zone expands from the posterior crown. In more pronounced cases, these zones match and the person is said to be clinically bald.
Importantly, three things need to occur in order for one to be affected by AGA. First, one must inherit the genetic predisposition. This means that the problem comes from one or both sides of the family. Second, one needs to attain a certain age. Nine year older children do not experience pattern hair loss. And third, one needs to have the circulating hormones that precipitate onset and progression of the disorder.
Typically, the earliest onset of AGA occurs in later puberty or one’s early 20’s. As a general rule, the earlier hair loss begins, the more pronounced it is likely to become.
Hormones, Enzymes & Other Factors
Crystallography of DHT molecule
From a susceptibility standpoint, the basic principle hormonal trigger linked to pattern hair loss is 5-alpha dihydrotestosterone, commonly referred to as DHT. Intriguingly, it has been shown that in people genetically insensitive to DHT, pattern hair loss does not occur. DHT is synthesized from the androgen hormone testosterone and is useful early in lifestyle and during puberty.
In adults, DHT is thought to cause significant harm, but very little good. Disorders simply because disparate simply because benign prostatic hyperplasia and pattern hair loss are both triggered by DHT. The synthesis of DHT happens via two carefully related forms of the enzyme 5-alpha reductase. Hair loss treatment options that efficiently interfere with the interaction between 5-alpha reductase and androgen hormones like testosterone have been shown to offer clinical benefit in treating pattern hair loss.
Because hair growth is regulated by multiple genes and attendant biochemical pathways, the underlying aspects are extremely complex. Another challenge to understanding hair loss has been the known fact that humans, alone among mammals, suffer from androgenetic alopecia. Thus, no efficient animal model exists that could otherwise tend to shed light upon the key factors at work.
Hair Loss Variations Other Than AGA
In either gender, the differential diagnosis is typically made based on the patient’s history and clinical display. The common differentials for AGA include alopecia areata (AA), Trichotillomania, and telogen effluvium. Less often, the cause of hair loss may be associated with disorders such as lupus erythematosis, scabies or other epidermis manifesting disease processes. Scalp lab and biopsy assay may be useful in ascertaining a definitive diagnosis, but, in such cases, should generally only follow an initial clinical evaluation by a qualified treating physician.
Pattern Hair Loss Treatment Options
It has wryly been observed that the choices for coping with hair loss are “rugs, plugs, or medications”. This quip articulates three treatment options that are more kindly referred to as non-surgical hair systems, surgical locks restoration, and pharmacotherapy.
Typical Hair Piece
Hair replacement systems have been in regular use at least since the right period of ancient Egypt. These products also go by the term hair integration systems, wigs, weaves, hair parts, toupees and many additional names. All have one thing in common—they are not growing out of one’s scalp. Thus, they must somehow be attached either with the bald epidermis or the fringe of locks remaining above the ears and in the back of the scalp.
Such attachment to the living scalp is almost never permanent, and for good reason. Aside from the fact that the unit itself wears out, basic hygiene dictates that the wearer regularly remove the unit to clean the underlying locks and scalp. There are more often than not three basic components to a hair alternative system. The first is the locks itself which may be synthetic, natural, or a combination thereof. The second element is the base of the unit. Generally, the locks is woven in to a fabric-like base which is then attached in some fashion to the scalp. This brings up the third element; which is the means of attachment. Methods include sewing the base to the fringe locks, gluing the base to the fringe locks, or gluing the base to the bald scalp.
Potential advantages to hair systems include the immediacy of achieving a full hair “look” that can appear, to the casual observer, to approximate a full head of hair. The potential disadvantages of locks systems are several and varied.
In persons who are actively losing hair, vs. those who are essentially bald, the hair system itself may accelerate the process of going bald rapidly. Another disadvantage is the hard leading edge that can give away the fact that a person is wearing a locks system. During the past, this problem has been addressed by using delicate lace front artificial hairlines that look quite natural but are generally extremely fragile.
Because they are nonliving, hair systems must be serviced and finally replaced themselves. The costs of servicing and sustaining a locks replacement system are not insubstantial–and such costs can dramatically exceed the initial price of acquisition.
Surgical Hair Restoration
Surgical hair restoration, often called hair transplantation, exploits a phenomenon very first described in the 1950’s. This phenomenon, donor dependence refers to the observation that locks bearing tissue, when relocated to an earlier balding area of the same person’s scalp, continues to produce viable, vigorously locks that persists in its brand-new location as it otherwise would, had it not been “relocated”. In appropriately selected patients, surgical locks restoration can constitute a positive solution to pattern hair loss
There are important caveats to hair transplantation. The first concerns supply and need. At the present time, one may not transplant hair from one person to another without causing a florid and destructive foreign body response in the recipient. Hence, both operator and patient are usually relegated to whatever long lasting hair bearing cells is in place. Accordingly, it is very important to save and strategically place this precious resource properly.
The second major caveat to hair transplantation concerns achieving beneficial endpoint results clinically. A hair line that is spotty or as well abrupt may look worse than it do before it was restored. By the same token, locks behind the leading edge that is not restored in a fashion that yields meaningful density (e.g. 1 locks per mm/sq) often fails to approximate a full head of hair. Therefore, in selecting a transplant surgeon, artistic excellence is at least equal in importance to basic surgical skill.
The third caveat to hair transplantation refers to a problem known as chasing a receding hair range. Because hair loss is usually progressive and relentless, it is possible that donor locks restored integrated into an apparently intact area of scalp locks may end up as an island of locks because the locks behind it continues to erode. In this situation, patients are compelled to augment locks behind the restoration zone in order to retain a full appearance. This works reasonably properly until either the locks stops thinning or one eventually runs out of donor locks.
Ideally, for persons undergoing transplant surgery, it will be helpful to incorporate a treatment option that properly and successfully arrested the progression of hair loss, allowing the treating surgeon to fill in the thin areas without the concern of chasing a receding hair line.
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